Cognitive Changes in Migraine: What do Mindfulness, Acceptance and Disability have to do with Self-Monitoring?

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Introduction: Migraine is a prevalent and disabling primary headache disorder. Treatment often involves headache self-monitoring. While self-monitoring has been associated with positive outcomes in other health populations, it has never been investigated in headache. Mindfulness and acceptance have emerged as potentially critical factors in headache. This study assessed relationships between headache-related disability, mindfulness and headache-related acceptance over time with headache self-monitoring in people with migraine.;Methods: Adults with migraine already enrolled in a mindfulness-based treatment trial participated in this study during their pre-trial baseline month. Participants were recruited across New York City via doctor referrals and fliers. They completed one month of daily headache self-monitoring, an initial demographic survey, and evaluations of headache-related disability, mindfulness, and headache-related acceptance and at the beginning, middle and end of the month. Outcome measures included the Headache Disability Index (HDI), the original 30-day and a 7-day version of the Migraine Disability Assessment (MIDAS and MIDAS-7), the Five Facet Mindfulness Questionnaire (FFMQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). We also analyzed mindfulness and acceptance subscales. Correlations assessed relationships between outcomes at each evaluation. Mixed models for repeated measures assessed change in outcomes over time.;Results: Participants (N = 40; 95.0% female; 90.0% White; 87.5%; Non-Hispanic; mean age = 40.2 years) completed 25 daily diaries on average. The CPAQ and FFMQ were not associated with the MIDAS or MIDAS-7. Higher scores on the CPAQ and its two subscales were consistently, strongly related to lower scores on the HDI (rs -.64 to -.79, ps < .001). At weeks 0 and 2 but not 4, higher scores on the FFMQ were related to lower scores on the HDI (r = -.52, p = .001, and r = -.43, p = .011). At week 0, higher scores on the Nonjudging FFMQ subscale were associated with lower scores on the HDI (r = -.53, p = .005). At week 4, lower scores on the Acting with Awareness FFMQ subscale were associated with severe disability on the MIDAS (t (33) = 2.995, p = .030). Outcome variables remained stable over time with two exceptions: the MIDAS decreased from week 0 to week 2, but the reduction was not sustained at week 4; and Acting with Awareness decreased from week 0 to week 2 and remained decreased through week 4.;Conclusions: Mindfulness and headache-related acceptance were associated with lower emotional but not functional headache-related disability. The relationship with acceptance was most consistent and strong. Acceptance-based treatments for migraine should be evaluated. Headache self-monitoring was associated with a temporary decrease in functional headache-related disability and a sustained decrease in the acting with awareness facet of mindfulness. Clinicians should be cognizant of possible decreases in migraine patients' attention and awareness during self-monitoring.